In the end, it was a defining characteristic of government the power to tax that saved the Affordable Care Acts constitutional bacon in the Supreme Court. That and Chief Justice John Roberts disinclination to overturn from the bench the historic votes on the House and Senate floors that extended health insurance coverage to nearly all Americans.
The result was a crucial victory Thursday for a national goal Democrats had pursued for decades. But more than a win for a political party, this was a big step toward the promise of better health care for all of us, even if challenges remain. High and rising health care costs must be addressed, and kinks in the lengthy Affordable Care Act must be ironed out as they come up.
But assuming a President Romney doesnt take office in January with enough support to overturn the law no longer will the United States remain just about the only advanced country lacking universal coverage. No longer will the worst aspects of our often-outstanding health care system work against us, bankrupting some unfortunate people who are badly hurt or fall seriously ill.
Help for families
No longer will children in families that make too much to qualify for existing Medicaid but too little to afford private insurance go uncovered in the face of unaffordable medical costs. No longer will pre-existing ills disqualify people from coverage. No longer will those who lose or change their jobs and employer-provided health insurance be left out in the cold. Real, tangible benefits will reach tens of millions more Americans.
Also, because the Affordable Care Act was upheld, the advances made as the fledgling act phases in will remain in place, including a familys ability to insure offspring until age 26.
Those gains would have been tossed aside or left to the tender mercies of insurers if the decision if Chief Justice Roberts had gone the other way. By the slimmest of margins, 5-4, Roberts and the courts four liberal members ruled with convincing logic that the route Congress took to expand coverage was indeed constitutional.
The individual mandate, Roberts wrote, doesnt pass muster based on the congressional power to regulate commerce, yet it is, he wrote, at its core a form of tax and if a government can do anything, it can tax. Whatever its called (and Republicans will make much of this new Democratic tax) the requirement that everyone have coverage makes sense in insurance terms. To keep costs low for all, the insurance pool needs to be wide and deep, and folks cant be allowed to buy in only when theyre about to need costly care.
Bay State mandate
Back when Congress was developing the health reform package, the issue of the mandates constitutionality seemed peripheral. Hadnt Republicans originally proposed it? And didnt then-Gov. Mitt Romney of Massachusetts cast the requirement as a tool to assure that people took responsibility for covering their own health care costs?
Yes and yes. But Congress stepped smack into an area of law the governments powers under the Constitutions Commerce Clause that conservatives on the Supreme Court have been itching to reduce. In Thursdays ruling they did, with Roberts finding that Congress has no power to compel people to, in effect, buy a product. (But to lay on a tax? That it can do, even if it doesnt call it a tax.)
Also gaining was an effort to rein in expansion of Medicaid, the federal-state health care program for the poor and disabled. The court said Washington cant take away the money it contributes to states current Medicaid programs if the states reject the Affordable Care Act.
That may tempt Republicans in some states lets hope not in North Carolina, where so many people lack coverage to try to undercut the act. Overall, though, that job will be harder now that the health care laws constitutionality has passed the Roberts Courts muster.